Bid Protests Cause DHS to Delay HealthChoices Implementation

March 03, 2017

Today, the Department of Human Services (DHS) announced a delay in the effective dates of the new managed care organization (MCO) agreements for HealthChoices, Pennsylvania’s mandatory Medicaid managed care program.

During January, DHS selected six MCOs to negotiate contracts with for the physical health care services of 2.2 million Medicaid consumers across the commonwealth. Subsequently, several of the non-selected bidders filed protests. Due to specific process requirements, the June 1 start date for new contracts no longer is viable.

Prior to a “go-live” or start date, DHS conducts an extensive readiness review (usually during a 90-day period) for each plan. Each MCO must successfully demonstrate that it can meet all the requirements contained in the agreement, including network adequacy, and “pass” this comprehensive review before it can begin formal operations and serve Medicaid consumers.

Additionally, DHS Secretary Ted Dallas said, “We have heard from advocates, consumers, and providers concerning the timeframe for implementing the new HealthChoices agreements, including how they will interact with the planned implementation for Community HealthChoices (CHC).” CHC is the Commonwealth’s new managed long-term supports and services plan targeted to begin January 1, 2018, in the southwest zone. As a result, DHS now is moving to a phase-in approach for the HealthChoices program beginning during January, 2018. The table below identifies the new start dates by zone:

Zone

HealthChoices Start Date

CHC Start Date

Southwest

January 2018

January 2018

Northwest

January 2018

January 2019

Northeast

March 2018

January 2019

Southeast

July 2018

July 2018

Lehigh/Capital

January 2019

January 2019

The chart below lists the existing MCOs currently delivering care, and the selected MCOs that likely will begin providing services during 2018:

Zone

Existing HealthChoices MCOs

HealthChoices MCOs
as of January 1, 2018

Southwest

Aetna Better Health

Gateway Health

United Healthcare of PA

UPMC for You

Gateway Health

PA Health and Wellness

UPMC for You

Vista—AmeriHealth Caritas Health Plan

Northwest

Aetna Better Health

AmeriHealth Caritas

Gateway Health

UPMC for You

Gateway Health

UPMC for You

Vista—AmeriHealth Caritas Health Plan

Northeast

Aetna Better Health

AmeriHealth Caritas

Geisinger Health Plan

Gateway Health

Geisinger Health Plan

UPMC for You

Southeast

Aetna Better Health

Health Partners Plans

Keystone First Health Plan

United Healthcare of PA

Gateway Health

Health Partners Plans

PA Health and Wellness

UPMC for You

Vista–Keystone First Health Plan

Lehigh/Capital

Aetna Better Health

AmeriHealth Caritas

Gateway Health

United Healthcare of PA

UPMC for You

Gateway Health

Geisinger Health Plan

Health Partners Plans

PA Health and Wellness

HAP recommends that member hospitals work with plans entering the specific geographic zones in which they operate in order to provide services to members enrolled in these MCOs.

HAP will continue to monitor the status of the HealthChoices implementation and provide additional updates as they become available.

For more information, contact Jolene Calla, HAP’s vice president of healthcare finance and insurance.